insulin restinstance

I am 4 yrs post-op and have had for the past 1 1/2 yrs severe hypoglycemia. I DO NOT eat ANY simple carbs have'nt since surgery, I eat a lot of protein through chicken and fish cheeses ect, I am lactose intolerant have been since 2 yr, and I have tried many other forms of "milks" soy, coconut, silk lactose free ect, but just can't stand the taste, so I do not drink protein shakes. I get a lot of protein from other foods. I do not eat anything greasy, fried, breaded, and NO SUGARS,I only use splendia in my house. I do not drink ANYTHING carbonated hurts my pouch, so it is always water, coffee or teas.Even at 4 yrs I have still lost weight 12 pds in the past 4 mos, I have met goal and then some at times, depends on my salt intake, actually salt is what I crave not anything sugary. Went to endo Dr who did a battery of tests and said that I am showing insulin resistance and has put me BACK on Metformin, a drug I took BEFORE my surgery, to see if that will help. I am very frustrated at this point, It is hard to get any Dr really work with me to get to the root of it all. I am today starting a 3 mo trial of the metformin and if that does not help, I will seek help from Cleveland Clinic, where I have heard that they have a group there that did a study on people like me that are having the same and some worse trouble with this rare side affect.  I take a lot of vitatims, and watch what I eat ALL the time, but my sugars will drop anywhere form 4- 7 hrs later at times. and some have fallen as low as 32, of course I am least aware not most of the time when it is coming on and I try to eat to help stabilize it sometimes it works other times it don't. I eat every 2-4 hrs, and I never go longer than 4 hrs without eating something, and in my job as an ER Med tech that can be hard at times when your slammed at work, so I carry food in my pockets all the time now. I am afraid too at losing my job, I have been sent home 4 times in the past 8 mos because of it, when I have a really bad attack I am useless for about an hr or so, very shaky, can't walk good, confused, foggy head ect.. So that does not help either. so has anyone else here ever had this? if so what did you do? any advise at this point I will gladly take. Thank you all for reading. God Bless 

Oh my I cried when I read this. I am experiencing exact same thing! My endo is having me keep a journal and will try to squeeze me in within the next 10 days. Please keep me posted as to your progress and if you ever need anybody to talk to feel free to message me!

I am sorry that you too are having this issue, Yes there are MANY out there like "me" I have come to find out through my own research on the web.I went back to my gastric surgeon and he tried to tell me it was late stage dumping. NO IT IS NOT! believe me the first yr out I dumped a few times, and this is NOTHING like that in the least, I can have it happen 6-7 hrs after a meal. Like I said I do not eat any simple carbs, only complex carbs, I do not drink anything carbonated, hurts my pouch. I eat only stuff that is 100% Whole Wheat, I am always looking for "new" foods that are high protein low on the glycemic scale and rich in vitamins. So make a list of questions to ask at ur appt, cause they want to go fast through the appt and if you don't you forget to ask somethings, Do not let them just dismiss you, make them run tests, check for any adrenal tumors,(I have one but they say it is non functioning) and check your pituary glands and hormones too.I am not sure where you are from, but I have read actricles over the past yr at varies places on the web that a group at Cleveland Clinic has done clinical trails on groups of ppl that are post RNY pts as much as 10 yrs out having these complaints. Me like a lot of them thought  I was going crazy at times,when it was my sugar all out of whack. There is new research out there that is connecting the link between RNY and Hypoglycemia, it only seems to affect those who have the RNY done. It has something to do with the Inlet cells in the small intestines, So I hope you have a good appt, just remember YOU are PAYING them to help YOU. Don't just let them dismiss it without running some important test. Also take your meter if you have one to show your readings, my lowest I had recorded was 31, it was in the middle of the night it woke me up (thank god) dripping in sweat, shaky, foggy head feeling, I now keep a meter on me and one I keep at my bedside, so when it happens I always check it and then I eat to help correct it, I keep a Jar of peanut butter on my bedside night stand. I wish you luck, let me know how it goes for you. God bless

If your sugar is dropping too low why are you back on Metformin?

I know several people who have had similar complications who weren't diabetics before surgery but after became extreme diabetics.

I had my first and--knock wood--only ostensibly non-food-related hypoglycemic attack a couple of weeks ago, at 9 months out. I am a diabetic in remission. Your experience sounds awful! My understanding of how metformin works is sketchy, but I think it evens out the liver's release of glycogen, so maybe it will help you. It plays heck with your daily life, not being able to predict when an episode might happen. Do keep us posted, and best of luck to you!

By the way, do you get lots of fiber? That's supposed to slow or regulate insulin release. Just a thought.

Yes she my Endo Dr. seems to think it will even me out, I have just started to add more fiber to my diet, so will see how that goes. I was a diabetic before my surgery found out 2 yrs before my surgery and was on that drug, She is putting me on the Long acting dose, so hopefully it will help. I am very cautious of what I eat. I NEVER try a "new" food away from home for the simple reason I don't know how I will react to it, so My eating out is almost non existent, this has had such an impact on my life, so I am hoping that this will help. I will try and post again in a few weeks to let ppl know how it is going. Thank You.

I think you should check on absorption of long acting metformin. If it's a time release or extended release, your RNY intestines might not absorb it fully. 

RH is not rare post op RNY. I am not  sure Metformin will help. 

I deal with that. And in last few month I was able to change my diet and now I very seldom get low BS. I think you may not be getting enough fats.  I removed most carbs from my diet - any grains, or starches, even complex starches caused my body to make too much insulin (the doc tested your insulin and since it was high - he diagnosed you with insulin resistant instead of of overproduction of insulin. There are not many docs who know what is going on with us. I went to one endocrinologist and he was trying to put me on steroids, and pills to cause constipation... grrrr...  Now I finally was able to see a doc who knows what is happening and we need to figure out what is happening me. 

In a meantime I changed my diet. Drastically.  I included more fat in my diet. It is a blessing. 

 

 

I increased my fat intake. I get the fat from natural sources: nuts, cheese, etc. I feel much better when I have more fat in my diet. How much? Not sure – I do not count the fat. I tried to count proteins, and calories. And to not have more than 15 gr of carbs per meal. I am trying to get no more carbs than I get protein in my meal. Most of the time - I get i.e. 20 gr of proteins , 5- 10 gr of fat and no more than 10 gr of carbs per meal.  It can be less carbs than 10 but not fat - my body needs fat to stabilize my sugar.   It is a diet. It is not normal eating. 

 

 

Controlling my BS in 2012-2013…

Realized that higher fat diet helps my BS – keeps it stable.  Eliminated gluten and most carbs, and low BS – hypoglycemia or RH – very seldom now, and only when I do something “stupid” (i.e eat sweets, yea – it happens…)

I also eliminated most processed foods (i.e. protein bars).  I try to eat as natural as I can, but lately bough and use some RTD (ready to drink) protein shakes that have splenda.

What do I eat in 2012 and 2013:

1. Meat and fish + veggies (low carb, low starch)
2. Eggs and egg whites (mixed with veggies and in food)
3. Cheese
4. Nuts and seeds, and nut butters (all of them)
5. Greek yogurt (at least 2% fat or whole fat ) but no more than 4oz . For the low fat version I add proteins and fat to it.
6. Natural fats: nut butters, butter, coconut oil, fat in real meats, cheese, flax meal, flax oil, avocado, etc.
7. Protein shakes – whey isolate and other proteins.  I avoid soy proteins. (have problem with excessive gas due to soy).
8. Diet: try to follow diet 1500 cal per day – app 120-150 gr of proteins 60 carbs, rest fat. 
9. I don’t eat meals –snacks that are only or mostly carbs.  I rarely eat carbs unless they are from veggies or nuts-seeds. 
10. I avoid sugar alcohols – not good for me.  I can tolerate some Erythritol. It does not make me hungry so far. 
11. Even natural sweeteners – honey fruit juices, milk -  may cause spike and then drop in BS. I don’t use that.

Thanks for the input, I don't do milk gives me horrible cramps, I can do soy or coconut milk. I can eat cheeses, and nuts. You said you do "nut butters" how much sugars do they have? Yes I did have a GTT done, she said my high was 184 and then went down to 50, but then hr later it "normal out" at about 70. I drink no fruit juices to sugary for me. I seem to be able to eat steel oats fine I add a few blueberries and walnuts splendia and  a splash of coconut milk, I only eat egg whites,(the yokes make me very gassy), I try and eat alot of veggies, but most make me gassy, my gastric Dr told me of a pill that was made of pt's who have an ostomy and for those of us that have "gas" issues post RNY in which is me it is called Devrom you can get it online 100 pills for 12.00 I buy it all the time, You still "pass gas" just take the "smell" out of it, seems to help. I have not found a protein shake yet that I can get down, the taste i can't get pass, there grit, so if you know of any that is better let me know. I can't eat hardly any beef or pork or lamb, they seem to sit like a rock in my pouch not comfortable. I do eat a lot of chicken, fish,tuna,peanut butter, I love crab meats. I can't do anything that is greasy or breaded at all. I can only eat 1 kind of bread that I seem to tolerate well it is Nickles 35 cal multigrain bread, thats all we use in my house now. there is a new on i have been seeing on a fb site that only has 1 impact carb i think it is called pabelo bread? thinking of buying 1 and trying.My diet guy told me to cut out any bananas, rasins,pears,peaches ect bcuz of the "natural " sugars.I nibble on nuts, fiber bars, whole grain rice cakes, a few grapes, and string cheese and whole grain crackers. I have to have foods that I can carry in my pocket at work( I work as an ER med tech in the emergency dept) so I have to "keep foods in my pocket that I can just pop in throughout the day. I have still lost weight the past 4-5 mos I seem to be leveling out around 130-136 depends on my salt intake, I crave salt it seems, and yeah she ck my thyroid too. So plz if you have any more suggestions I am open to any. Thanks

I don't eat any bread. A few months ago I went on a decarb diet with a friend - and gave up all grains - specially gluten.. surprisingly - after 2 weeks my BS stabilized and now I can be with no food for hours.. (unless I do something stupid).    I was able to put back in some fruits, and even some desserts (like real chocolate - dark, or gasp - cheesecake). 

Bread - there is no bread or crackers that I would eat now. None... it is not worth the  trouble. Cheese sticks, nuts, etc.. are one of my "to go" foods. Nut butter - I make sure I buy the natural - No Sugar Added version. (check on the label) .  I bake my own protein muffins and make protein pancakes (some of them I dry so they are crispy and don't spoil - and I use them as "crackers". 

I bake 2-3 batches and either keep in a fridge or even freeze, and take as much as I need